Provider Demographics
NPI:1669905931
Name:MAHAJAN, ABHINAV (MD, DPT)
Entity type:Individual
Prefix:
First Name:ABHINAV
Middle Name:
Last Name:MAHAJAN
Suffix:
Gender:
Credentials:MD, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 SPYRES WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9804
Mailing Address - Country:US
Mailing Address - Phone:209-578-3290
Mailing Address - Fax:209-550-4944
Practice Address - Street 1:4660 SPYRES WAY
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9804
Practice Address - Country:US
Practice Address - Phone:209-578-3290
Practice Address - Fax:209-550-4944
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT2915222251X0800X, 225100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program